Kidney replacement and conservative therapies in rhabdomyolysis: a retrospective analysis

Abstract

Background Toxic renal effects of myoglobin following rhabdomyolysis can cause acute kidney injury (AKI) with the necessity of kidney replacement therapy (KRT). Fast elimination of myoglobin seems notable to save kidney function and intensify kidney repair. Clinical data regarding efficacy of KRT in critical care patients with rhabdomyolysis and AKI are limited. This retrospective analysis aimed to identify differences between conservative therapy and different modalities of KRT regarding myoglobin elimination and clinical outcome. Methods This systematic, retrospective, single-center study analyzed 328 critical care patients with rhabdomyolysis (myoglobin > 1000 µg/l). Median reduction rate of myoglobin after starting KRT was calculated and compared for different modalities. Multivariate logistic regression models were established to identify potential confounder on hospital mortality. Filter lifetime of the various extracorporeal circuits was analyzed by Kaplan–Meier curves. Results From 328 included patients 171 required KRT. Health condition at admission of this group was more critical compared to patient with conservative therapy. Myoglobin reduction rate did not differ between the groups (KRT 49% [30.8%; 72.2%] vs. conservative treatment (CT) 61% [38.5%; 73.5%]; p = 0.082). Comparison between various extracorporeal procedures concerning mortality showed no significant differences. Hospital mortality was 55.6% among patients with KRT and 18.5% with CT (p < 0.001). Multivariate logistic regression model identified requirement for KRT (OR: 2.163; CI: 1.061–4.407); p = 0.034) and the SOFA Score (OR: 1.111; CI: 1.004–1.228; p = 0.041) as independent predictive factors for hospital mortality. When comparing specific KRT using multivariate regression, no benefit was demonstrated for any treatment modality. Life span of the extracorporeal circuit was shorter with CVVH compared to that of others (log-Rank p = 0.017). Conclusions This study emphasizes that AKI requiring KRT following rhabdomyolysis is accompanied by high mortality rate. Differences in myoglobin reduction rate between various KRTs could not be confirmed, but CVVH was associated with reduced filter lifetime compared to other KRTs, which enable myoglobin elimination, too. Graphical Abstract

Myoglobin adsorption and saturation kinetics of the cytokine adsorber Cytosorb® in patients with severe rhabdomyolysis: a prospective trial

“…They observed a significant higher probability of kidney recovery and significant lower myoglobin levels in patients receiving CS therapy [ 33 ]. Most recently, de Fallois et al compared conservative management of rhabdomyolysis (without RRT) with extracorporeal therapies using different modalities, dialyzers, and an adsorber [ 34 ]. There were no significant differences in myoglobin reduction between the RRTs or between RRT and conservative treatment, but no information was given on the changing interval of CS [ 34 ].…”

“…Most recently, de Fallois et al compared conservative management of rhabdomyolysis (without RRT) with extracorporeal therapies using different modalities, dialyzers, and an adsorber [ 34 ]. There were no significant differences in myoglobin reduction between the RRTs or between RRT and conservative treatment, but no information was given on the changing interval of CS [ 34 ]. In fact, patients without the need of RRT had the highest rate of myoglobin reduction, so preserving patients´ own renal function should be the primary goal in patients with rhabdomyolysis [ 34 ].…”

“…There were no significant differences in myoglobin reduction between the RRTs or between RRT and conservative treatment, but no information was given on the changing interval of CS [ 34 ]. In fact, patients without the need of RRT had the highest rate of myoglobin reduction, so preserving patients´ own renal function should be the primary goal in patients with rhabdomyolysis [ 34 ]. Therefore, CS therapy as a stand-alone device should be discussed in the future to perhaps prevent the kidney damaging effects of myoglobin.…”